Musculoskeletal System NCLEX Questions

Musculoskeletal System NCLEX Questions

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NUR 10

20 terms mar The bone cells that function in the resorption of bone tissue are called

• osteoids.
• osteocytes.
• osteoclasts.
• osteoblasts.

Correct answer: c

Rationale: Osteoclasts participate in bone remodeling by assisting in the

breakdown of bone tissue.While performing passive range of motion for a patient, the nurse puts the ankle joint through the movements of (select all that apply)

• flexion and extension.
• inversion and eversion.
• pronation and supination
• flexion, extension, abduction, and adduction.
• pronation, supination, rotation, and circumduction.

Correct answers: a, b

Rationale: Common movements that occur at the ankle include inversion, eversion, flexion, and extension.

To prevent muscle atrophy, the nurse teaches the patient with a leg immobilized in traction to perform (select all that apply)

• flexion contractions.
• tetanic contractions.
• isotonic contractions.
• isometric contractions.
• extension contractions.

Correct answer: d

Rationale: Isometric contractions increase the tension within a muscle but do not produce movement. Repeated isometric contractions make muscles grow larger and stronger. Muscular atrophy (i.e., decrease in size) occurs with the absence of contraction that results from immobility.A patient with tendonitis asks what the tendon does. The nurse's response is based on the knowledge that tendons

• connect bone to muscle.
• provide strength to muscle.
• lubricate joints with synovial fluid.
• relieve friction between moving parts.

Correct answer: a

Rationale: Tendons are composed of dense, fibrous connective tissue that

contains bundles of closely packed collagen fibers arranged in the same plane for additional strength. They connect the muscle sheath to adjacent bone.The increased risk for falls in the older adult is most likely due to

• changes in balance.
• decrease in bone mass.
• loss of ligament elasticity.
• erosion of articular cartilage.

Correct answer: a

Rationale: Aging can cause changes in a person's sense of balance, making the

person unsteady, and proprioception may be altered. The risk for falls also increases in older adults partly because of a loss of strength.While obtaining subjective assessment data related to the musculoskeletal system, it is particularly important to ask a patient about other medical problems such as

• hypertension.
• thyroid problems.
• diabetes mellitus.
• chronic bronchitis.

Correct answer: c

Rationale: The nurse should question the patient about past medical problems

because certain illnesses are known to affect the musculoskeletal system directly or indirectly. These diseases include tuberculosis, poliomyelitis, diabetes mellitus, parathyroid problems, hemophilia, rickets, soft tissue infection, and neuromuscular disabilities.

When grading muscle strength, the nurse records a score of 3, which indicates

• no detection of muscular contraction.
• a barely detectable flicker of contraction.
• active movement against full resistance without fatigue.
• active movement against gravity but not against

resistance.

Correct answer: d

Rationale: Muscle strength score of 3 indicates active movement only against

gravity and not against resistance (see Table 62-4).A normal assessment finding of the musculoskeletal system is

• no deformity or crepitation.
• muscle and bone strength of 4.
• ulnar deviation and subluxation.
• angulation of bone toward midline.

Correct answer: a

Rationale: Normal physical assessment findings of the musculoskeletal system

include normal spinal curvatures; no muscle atrophy or asymmetry; no joint swelling, deformity, or crepitation; no tenderness on palpation of muscles and joints; full range of motion of all joints without pain or laxity; and muscle strength score of 5.A patient is scheduled for an electromyogram (EMG). The nurse explains that this diagnostic test involves

• incision or puncture of the joint capsule.
• insertion of small needles into certain muscles.
• administration of a radioisotope before the procedure.
• placement of skin electrodes to record muscle activity.

Correct answer: b

Rationale: Electromyography (EMG) is an evaluation of electrical potential

associated with skeletal muscle contraction. Small-gauge needles are inserted into certain muscles and attached to leads that record electrical activity of muscle. Results provide information related to lower motor neuron dysfunction and primary muscle disease.A 54-year-old patient admitted with cellulitis and probable osteomyelitis received an injection of

radioisotope at 9:00 AM before a bone scan. The nurse

should plan to send the patient for the bone scan at what time?

a. 9:30 PM

b. 10:00 AM

c. 11:00 AM

d. 1:00 PM

C A technician usually administers a calculated dose of a radioisotope 2 hours before a bone scan. If the patient was injected at 9:00 AM, the procedure should be done at 11:00 AM. 10:00 AM would be too early; 1:00 PM and 9:30 PM would be too late.

A 54-year-old patient is about to have a bone scan. In teaching the patient about this procedure, the nurse should include what information?

• Two additional follow-up scans will be required.
• There will be only mild pain associated with the

procedure.

• The procedure takes approximately 15 to 30 minutes to

complete.

• The patient will be asked to drink increased fluids after

the procedure.D Patients are asked to drink increased fluids after a bone scan to aid in excretion of the radioisotope, if not contraindicated by another condition. No follow-up scans and no pain are associated with bone scans that take 1 hour of lying supine.Musculoskeletal assessment is an important component of care for patients on what type of long-term therapy?

• Corticosteroids
• β-Adrenergic blockers
• Antiplatelet aggregators
• Calcium-channel blockers

A Corticosteroids are associated with avascular necrosis and decreased bone and muscle mass. β-blockers, calcium-channel blockers, and antiplatelet aggregators are not commonly associated with damage to the musculoskeletal system.A female patient with a long-standing history of rheumatoid arthritis has sought care because of increasing stiffness in her right knee that has culminated in complete fixation of the joint. The nurse would document the presence of which problem?

• Atrophy
• Ankylosis
• Crepitation
• Contracture

B Ankylosis is stiffness or fixation of a joint, whereas contracture is reduced movement as a consequence of fibrosis of soft tissue (muscles, ligaments, or tendons). Atrophy is a flabby appearance of muscle leading to decreased function and tone. Crepitation is a grating or crackling sound that accompanies movement.The nurse is performing a musculoskeletal assessment of an 81-year-old female patient whose mobility has been progressively decreasing in recent months. How should the nurse best assess the patient's range of motion (ROM) in the affected leg?

• Observe the patient's unassisted ROM in the affected

leg.

• Perform passive ROM, asking the patient to report any

pain.

• Ask the patient to lift progressive weights with the

affected leg.

• Move both of the patient's legs from a supine position

to full flexion.A Passive ROM should be performed with extreme caution and may be best avoided when assessing older patients. Observing the patient's active ROM is more accurate and safe than asking the patient to lift weights with her legs.In reviewing bone remodeling, what should the nurse know about the involvement of bone cells?

• Osteoclasts add canaliculi.
• Osteoblasts deposit new bone.
• Osteocytes are mature bone cells.
• Osteons create a dense bone structure.

B Bone remodeling is achieved when osteoclasts remove old bone and osteoblasts deposit new bone. Osteocytes are mature bone cells, and osteons or Haversian systems create a dense bone structure, but these are not involved with bone remodeling.